title: Predictors and long-term prognostic significance of angiographically visible distal embolization during primary percutaneous coronary intervention.
abstract: OBJECTIVE
  We aimed to identify the predictors of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) as well as to assess its impact on short- and long-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  We retrospectively enrolled 2007 patients with STEMI who underwent p-PCI. We assessed the clinical and angiographic characteristics of patients in order to identify the predictors of AVDE and compared the outcomes of patients with and without AVDE during p-PCI.
  
  
  RESULTS
  Distal embolization developed in 135 (6.7%) patients. Age (for each 10- year increase, Odds Ratio (OR) 1.34, 95% Confidence Interval (CI) 1.16-1.52, p<0.001), treatment of right coronary artery (OR 2.52, 95% CI 1.30-4.87, p=0.034), repeated balloon dilatation (OR 1.84, 95% CI 1.16-2.94, p=0.009), cut-off occlusion pattern (OR 2.17, 95% CI 1.38-3.42, p=0.001), lesion length >15 mm (OR 1.67, 95% CI 1.09-2.58, p=0.019), and reference vessel diameter >3.5 mm (OR 5.08, 95% CI 3.32-7.65, p<0.001) were independent predictors of AVDE. In-hospital (8.1% vs. 3.8%, p=0.014) and one-month (10.8% vs. 4.9%, p=0.004) all-cause mortality rates were higher in patients with AVDE. At the long-term follow-up (median: 42 months), both all-cause (21.5% vs. 10.4%, p<0.001) and cardiac mortality rates (18.4% vs. 8.0%, p<0.001) were higher in patients with AVDE.
  
  
  CONCLUSIONS
  AVDE is associated with worse clinical outcome at both the short- and long-term follow-up of STEMI patients treated early with p-PCI.
authors.affiliation: Department of Cardiology, Medical Park Fatih Hospital, İstanbul, Turkey.
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.forename: Taylan
authors.initials: T
authors.lastname: Akgün
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Tanboğa
authors.forename: Selçuk
authors.initials: S
authors.lastname: Pala
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
authors.forename: Ali Metin
authors.initials: AM
authors.lastname: Esen
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D004617:Embolism / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors